Addison's disease and severe encephalopathy in an infant with HIV infection.

AIM: To discuss the overlapping clinical spectrum of encephalopathy due to Addison's disease and HIV infection.

PATIENT: We report a 2.5-year-old boy from Uzbekistan with recurrent episodes of encephalopathy and seizures, triggered by infection or vaccinations, in whom adrenal insufficiency and infection with HIV and HCV was diagnosed. Presumably, Addisonian crises prompted hypovolemic shock and blood transfusions, which were responsible for horizontal HIV infection. The combination of adrenal insufficiency and HIV infection eventually led to progressive severe encephalopathy. Despite highly active antiretroviral therapy (which led to substantial reduction of blood viral load), the neurological condition did not improve.

DISCUSSION: The interactions of Addison's disease and HIV in the pathogenesis of encephalopathy are discussed.